Baby died after mother given high dose of labour drug, inquiry hears

An inquiry into the care of three mothers by a consultant obstetrician heard a patient received an unnecessarily high dose of a labour medication that can lead to foetal distress.

The disciplinary hearing, held by the Medical Council in Lucan, Co Dublin, also heard that one of the babies was too high in his mother's pelvis for a vaginal birth to be possible, despite repeated attempts on the part of the doctor.

Dr Salah Aziz Ahmed faces allegations of poor professional performance and professional misconduct relating to three women who gave birth at Cavan General Hospital between November 2012 and April 2014.

Last week, the inquiry heard details involving one of the patients, a 37-year-old woman, referred to as Patient One, whose baby died 32 hours after he was born. The baby was born by emergency caesarean section on the night of November 22nd, 2012 and it is alleged that Dr Aziz failed to start the procedure in a timely manner.

Expert witness Joanna Gillham, a consultant obstetrician based in St Mary's Hospital in Manchester, told the inquiry on Monday the increments in which syntocinon, a labour medication, was administered to Patient One during her labour exceeded hospital guidelines.

Dr Gillham said syntocinon, used to strengthen and increase contractions, can be used to very good effect to help progress labour. However, if used incorrectly, she said, it can cause foetal distress.

In the evening of November 22nd, the syntocinon administered to Patient One was increased from 90mls per hour to 180mls. This increase “was unnecessary and could lead to foetal compromise”, Dr Gillam said.

Dr Aziz faces allegations regarding the dosage of syntocinon administered to Patient One.

Criticisms of care

Eileen Barrington SC, representing Dr Aziz, said her client would argue the syntocinon was increased in the hope of facilitating the success of an instrumental vaginal delivery.

But Dr Gillham disagreed with this approach and, referring to the increase, said, “I cannot see it was clinically justified”.

Under cross-examination, Dr Gillham said she had a number of criticisms of the midwifery care provided to Patient One, both in regard to the administration of syntocinon and the CTG (or electronic foetal monitoring).

She said both the dilution of the syntocinon and the increments in which it was given to Patient One was not in accordance with hospital guidelines.

Ms Barrington reminded the inquiry that the cause of death in the case of Patient One’s baby did not form any part of the allegations.

Dr Aziz denies the allegations against him. The inquiry continues.